Matching EHR Tool to Task: Making it Easier to Care
-
Upload
jeff-belden-md -
Category
Health & Medicine
-
view
272 -
download
0
Transcript of Matching EHR Tool to Task: Making it Easier to Care
The Patient and the Electronic Health Record: Where are we? Where are we going?
Matching EHR Tool to Task: Making It Easier to CareI-PrACTISE | April 2016
Jeffery L. Belden, MD | ProfessorRichelle J. Koopman, MD, MS | Associate Professor
UNIVERSITY OF MISSOURIFamily & Community Medicine
UNIVERSITY OF MISSOURIFamily & Community Medicine1David
AcknowledgementsWe have no conflicts to declare.
Grant support includes:Grant #1R01HS023328 from AHRQ. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.California HealthCare Foundation and SHARP-C Project of the ONC supported inspiredEHRs.org.
UNIVERSITY OF MISSOURIFamily & Community Medicine
2
ObjectivesDemonstrate human factors principles at work in EHR designExamine the influence on the physical environment on the work of primary care office visits Forecast future trends in EHR design
UNIVERSITY OF MISSOURIFamily & Community Medicine
3
Designing EHR toolsUnderstanding the information needs of the userUnderstanding the tasks of the userUnderstanding the context of the workDesigning to make information clearerDesigning to aid decision-making
UNIVERSITY OF MISSOURIFamily & Community Medicine
4
Our history
UNIVERSITY OF MISSOURIFamily & Community Medicine
5
EHR evolutionStand-alone in your office/hospitalAble to get labsAble to get discharge summariesAble to see ER and consultant reports, link hospital and officeE-prescribingPatient portalsHealth Information Exchange (HIE)
UNIVERSITY OF MISSOURIFamily & Community Medicine
6
Our history
UNIVERSITY OF MISSOURIFamily & Community Medicine
7
Tabbed Dividers
UNIVERSITY OF MISSOURIFamily & Community Medicine
8
Working Memory
UNIVERSITY OF MISSOURIFamily & Community Medicine
9
Cognitive Load
UNIVERSITY OF MISSOURIFamily & Community Medicine
10
Start a note by dumping the data into the note for review
Health Status Allergies: . Allergic Reactions (Selected)Lamisil- Rash.Severity not DocumentedLevaquin- Rash, hives. Current medications: Medication Orders (selected)amloDIPINE 10 mg Tab, 10 mg, 1 Tablet, Oral, qAMhydrochlorothiazide 25 mg Tab, 25 mg, 1 Tablet, Oral, qAMPrescriptions and Home Medications (selected)fluticasone (Flovent), 88 mcg 2 puffs daily, 1hr AC, 2 Each, 0methylphenidate (Metadate CD 20 mg/24 hr oral capsule, extended release), 20 mg, 1 Capsule, Oral, qAM, 30 Capsule, 0 Problem list: All Problems (Selected)Smoker / ICD-9-CM 305.1 / ConfirmedMigraine HAs / ICD-9-CM 346.01 / ConfirmedHypertension / ICD-9-CM 997.91 / ConfirmedCalculus of kidney / ICD-9-CM 592.0 / Confirmed Review of Systems Constitutional: Fever, Fatigue, Decreased activity. Eye: No discharge. Ear/Nose/Mouth/Throat: No ear pain, No nasal congestion. Respiratory: No shortness of breath, No cough. Cardiovascular: No chest pain. Gastrointestinal: No nausea, No vomiting, No diarrhea, No constipation, No abdominal pain. Genitourinary: No dysuria. Endocrine: No excessive thirst, No polyuria. Immunologic: No recurrent fevers, No recurrent infections. Musculoskeletal: Muscle pain, No neck pain. Integumentary: No rash. Neurologic: Headache. Psychiatric: Negative.
UNIVERSITY OF MISSOURIFamily & Community Medicine
11
Cognitive OverloadInformation to be processed exceeds the processor, i.e. working memory
UNIVERSITY OF MISSOURIFamily & Community Medicine
12
Dashboard Design
UNIVERSITY OF MISSOURIFamily & Community Medicine
13
Dashboard Design: Nudge
UNIVERSITY OF MISSOURIFamily & Community Medicine
14
Dashboard EfficienciesSaved over 4 minutesSaved 50 clicksIncreased accuracy
Satisfaction and Satisficing
UNIVERSITY OF MISSOURIFamily & Community Medicine
15
Seeing the big picture
UNIVERSITY OF MISSOURIFamily & Community Medicine
16
My MissionEmpathy for the user
18
My MissionTo relieve physician suffering by improving the usability of the software they use
19
My MissionTo bring physicians joy by making their software delightful to use
20
The VisionInspired EHRs: Designing for CliniciansFor HIT vendorsFree, online at inspiredEHRs.org
21
The Medication ListMore like a dozen listsStarted with an idea about
22
Varieties of Medication ListsProvider viewsSimple ListTreatment & Renewals List Timeline ViewBurst or intermittent therapyPeri-proceduralTried and FailedMedication Reconciliation ListPatient viewsBasic Pocket ListDaily Reminder ListReminder for Refills ListEnd of Visit ListRestock the Medi-minder List more complexmore complex
Note the users. Note the complexity range.23
Which Medication List
User?Task at hand?
UNIVERSITY OF MISSOURIFamily & Community Medicine
24
Reading the Medication List
in a progress note
UNIVERSITY OF MISSOURIFamily & Community Medicine
25
UNIVERSITY OF MISSOURIFamily & Community Medicine
UNIVERSITY OF MISSOURIFamily & Community MedicineAnother Medication List
for managing medication renewals
UNIVERSITY OF MISSOURIFamily & Community Medicine
28
UNIVERSITY OF MISSOURIFamily & Community Medicine
UNIVERSITY OF MISSOURIFamily & Community MedicineChallengesWhy cant clinicians get what they want?Now!
31
Design Thinking
UNIVERSITY OF MISSOURIFamily & Community Medicine
32
desirablefeasiblecliniciansengineers
desirablefeasibleviablecliniciansengineersvendors
ChallengesFundingSetting Scope
Building the teamVendors | Human Factors | Designers | Clinicians
Selling the conceptinspirational, not prescriptive
UNIVERSITY OF MISSOURIFamily & Community Medicine
35
ChallengesWhats in a name?
Style GuideThou shall
Inspired EHRs:Designing for Clinicians
UNIVERSITY OF MISSOURIFamily & Community Medicine
36
UNIVERSITY OF MISSOURIFamily & Community MedicineClinical ScenariosEmpathize with the clinicians thinking
ImagesBefore & After Comparisons
Links to HF Principles
Jump to HF Chapter
with examplesgeneral example
specific to EHRHIT specific example
TwinlistMedication Reconciliation | Prototype
44
Twinlist videoPlay bit.ly/TwinlistVideo
TimelineThe story of the medicationsWhen did we start?Why / when did we stop?Why did we change?Why arent you taking what I expected?
So hard to find
46
Timeline | starting with sketchs
47
Timeline Prototype
48
Timeline Prototype
49
Toll, E.The Cost of TechnologyJAMA 2012.Technology in the Exam Room
Typical Exam Room
Something new? Better?
MethodsVideo-recorded 60 patient visits for chronic care follow-up in 2 practices5 patients each for 12 docsCoded videos for physician and patient gazePhysician-patientPhysician-computerPatient-computerIncidental viewingCollaborative viewing
54
Time Spent (minutes)Laptops30 inch screensp valueTotal Visit18.721.70.06Patient Physician Mutual Gaze15.015.90.52Physician alone viewing screen5.53.20.01Collaborative viewing of screen0.61.60.03
Compared to laptop rooms (32%) patients invited to view the screen in 63% of visits in 30 inch screen rooms, p = 0.03
Backwards?
Better
Compared to laptop rooms (32%) patients invited to view the screen in 63% of visits in 30 inch screen rooms, p = 0.03
Tables and GraphsWhen tables were viewed (45% of visits), they were shared with patients 38% of the timeWhen graphs were viewed (18% of visits), they were shared with patients 100% of the time
It gives you more of a perspective. Numbers dont mean a whole lot. But when you can see the curvature and the form that it takes you have a better perspective of what is going on.
59
BP Graphing
60
iPad graph
Margaret
Incorporating Home BP
UNIVERSITY OF MISSOURIFamily & Community MedicineAdding a medication timeline
UNIVERSITY OF MISSOURIFamily & Community MedicineOutlier Fills?
UNIVERSITY OF MISSOURIFamily & Community MedicineReal Home BP Data
UNIVERSITY OF MISSOURIFamily & Community MedicineFuture EHR Tool DesignDesign for shared physician-patient experienceIncorporate patient-generated dataMoving from page paradigm to data visualizationPayment regulation reform needed
UNIVERSITY OF MISSOURIFamily & Community Medicine
67
Questions?
UNIVERSITY OF MISSOURIFamily & Community Medicine
68
Questions?Richelle Koopman MD [email protected]
Jeff Belden [email protected]: jeffbeldeninspiredEHRs.orgtoomanyclicks.com
UNIVERSITY OF MISSOURIFamily & Community Medicine
69